The nurse’s responsibilities have changed and increased in conjunction with the expansion of the nurse’s role. Patients and their families now, quite rightly, expect the nurse to have the answers and to practise in an efficient, safe and effective way. With this expectation, comes the the risk that if the nurse does not provide research-based care, the patient or family is increasingly likely to call the nurse to account. This may be through the hospital or community trust’s complaints mechanism, via the United Kingdom Central Council’s (UKCC) professional conduct committee or, ultimately, through the legal system and courts.

In line with these changes, education of nurses has begun to change quite drastically. It is now fully university-based and is becoming much more rigorous in its approach to the teaching of research. A major part of the nurse’s role now includes the use of evidence-based practice to underpin the care and treatment he or she dispenses. Over the past 30 years or so in the UK, there has been a growing effort made in nursing towards research-based practice and this has helped, at least in part, to establish nursing as a true profession. This growing professional concern with the best-quality care has matched increasing governmental directives for evidence-based practice to become the norm. Research is seen by all as essential for improving and developing nursing care, aiding the evaluation of care and providing clearer guidelines for practice. This is clearly beneficial to the National Health Service (NHS) and, of course, to the patient.

Up-to-date information and research can be used to change practice, enhance clinical care and assist in the reorganisation of care in the rapidly changing world of healthcare. As well as the changes to pre-registration nurse education, there has been an increase in the

The importance of research in nursing practice

provision of continuing education for qualified nurses. This is due, in part at least, to the implementation of the Post-Registration, Education and Practice scheme (PREP) introduced by the UKCC. Many nurses are also working towards higher academic qualifications, such as diplomas and degrees. Research-awareness modules are an integral part of all these courses.

Action point

• • • • • Take some time to think about how you feel about research in nursing. Do you use it in your job regularly? Do you feel at ease with it? Do you think you know enough about research? What are you going to do about it?

Research in healthcare

Until recently, the nursing profession in general has not placed a great deal of importance on research. Indeed, comparatively little nursing research has been undertaken in Britain and even less has been implemented. Practice has been based predominantly on historical approaches to care rather than following clear evidence of good practice. In recent years, however, there has been a refocusing on the need for research in the light of several government reports and statements made by academics relating to research:

•‘Nursing MUST become a research-based profession’ was stated as long ago as 1972 in the Report of the Committee on Nursing (Briggs Report).

•‘Research is a way of thinking. It demands a critical approach to knowledge, an ability to formulate relevant questions and to search for answers’ (Greenwood 1984).

•In Every Nurse’s Business came the statement that ‘The most important issue for research and development is to enhance the capability of all nurses to contribute to research and development both locally and nationally’ (Trent Regional Health Authority 1993).

Research-based nursing practice is of vital importance for nursing today, and will, if supported, allow nurses and midwives to practise competently and with confidence. All nurses and midwives in hospitals, the community and the private sector must utilise research in all areas of practice in accordance with their requirement for accountability and responsibility (UKCC 1986). Research findings offer the nursing profession opportunities to enhance nursing care while expanding the body of nursing knowledge. This will certainly help nursing and midwifery to maintain and enhance the vital role it has in modern healthcare. The widespread introduction and use of research will, we believe, be one of the most important factors in the new era of nursing. This book has been written with this in mind, and is designed to provide the reader with the necessary background knowledge to understand better the research process. It is also written in such a way as to provide the nurse or healthcare professional with a great many practical suggestions and guidelines on how research-based practice may be implemented successfully in the clinical area.

The meaning of research in healthcare

The aim of research is to establish what best practice should be by producing evidence. Development is concerned with the planned, systematic introduction of research into healthcare practice by changing current practice if required. The research or audit process may help healthcare professionals identify the need for such developments.

Introducing change: the case for research

As highlighted above, the implementation of evidence-based care into clinical nursing practice has long been recognised as an important issue (Bassett 1995). However, the nursing profession is still struggling to base practice developments on research findings (Hunt 1981; Greenwood 1984; Lobiondo-Wood 1986).

The Department of Health document Report of the Taskforce on the Strategy for Research in Nursing, Midwifery and Health Visiting (DoH 1993b) stresses the need for research-based practice to become the common practice. Other authors have highlighted the benefits of this in terms of improved care with increased patient satisfaction. But despite the clear advantages reported in many papers, research-based practice is The importance of research in nursing practice 5

not as widespread as one might hope. In addition, there is a clear requirement for those working within NHS trusts and primary care groups (PCGs) to put the growing number of healthcare policies, such as Health of the Nation (DoH 1992), A Vision for the Future (DoH 1993a) and Working in Partnership (DoH 1994a), into action. British healthcare and nursing have not begun to meet the requirements described in these policies and this has led to the presence of not only a ‘theory/practice’ gap, but also a ‘policy/practice gap’ (Cutcliffe and Bassett 1997).

Auditing healthcare outcomes

In the context of health and illness, outcome is usually defined in terms of the achievement of or failure to achieve desired goals (Delamothe 1995).

Audit concerns the monitoring of current practice against standards, preferably employing criteria derived from research findings on best practice in addition to professional and management judgement and consumer preference. The relationship between research and practice is dynamic: research findings inform practice and practitioners inform research by identification of issues to be investigated. Not all nurses are required to undertake research – this would be unfeasible, because if they did, who would be left to look after the patients? However, all nurses should have the knowledge to become involved in the utilisation of valid research findings in their practice. As stated above, all nurses should have research awareness. Recommendations from the DoH (1994a) state that all nurses/midwives have a responsibility to be aware of research. There is, therefore, the expectation that all nurses will do the following.

Action point

• • • • Question and critically evaluate current professional practice. Keep up-to-date with research-based knowledge in their clinical field and utilise where appropriate. Protect the rights of patients who have agreed to participate in research. Do you do all of the above?

Implementing Research in the Clinical Setting

Research appreciation

This factor is considered to be a natural progression from research awareness. It is here that the nurse’s questioning attitude is channelled into finding out how research is carried out. Many nurses and midwives have undertaken research appreciation courses, often as part of a diploma, degree or master’s programme of pre- or post-basic education.

Appreciation involves:

the critical analysis of research findings nderstanding methodologies being familiar with the research process ifluencing colleagues in the use of research data developing responsibility for one’s own professional development in research.

As part of the strategy of increasing research usage in practice, we need to foster those who want to be involved in research. This will help ensure that resources are made available to meet each nurse’s future educational needs regarding research awareness and application training.

Research application

If managed carefully this aspect of research can really make a difference to the nurse’s daily practice. It can have the following benefits:

•Increased knowledge of illness, treatment and care leading to competent care and direct benefit to patients.

•Clearer more timely identification of effective resource management.

•Research utilisation raising the profile of nurses and midwives and promoting the status of the profession.

Differing approaches to research

Different types of research methodology can be used to enhance practice; these will be touched on throughout the book. Quantitative research underpins certain types of practice, whereas the application The importance of research in nursing practice

of social science research with a qualitative approach encourages a holistic, humanistic approach to patient care. The number of nurses and midwives presently engaged in research application is growing but it needs to be quantified to ensure resources are available for future educational needs.

Research ability

Healthcare technology assessment is an area of increasing importance to every nurse. Used in the widest possible sense, it refers to techniques, drugs, equipment and procedures used by healthcare professionals in the delivery of healthcare and rehabilitation to individuals, and the systems within which such care is delivered. It denotes any processes involving safety, efficacy, feasibility, indications for use, cost and cost-effectiveness, as well as social, economic and ethical consequences of care.

For nurses and midwives this may involve any or all of the following:

•The assessment of health technologies as part of routine practice and also in major clinical trials.

•Projects undertaken as part of a post-registration course.

•Action research: review and replication of previous studies.

•Nurses and midwives assisting medical staff in clinical trials.

Purchasers’ requirements

Users and purchasers of healthcare services, e.g. PCGs, will also have their own requirements relating to research in the trusts, including:

•proof of research and audit

•evaluation of practice within the contracting process

•evidence of outcomes.

The drive for research in nursing and healthcare

Nursing as a profession has come to acknowledge the requirement to develop its own body of knowledge to meet the fast-changing health-care needs of society. Practice is not consistently based on sound empirical evidence; we need well-researched evidence to help evaluate care given and, ultimately, change practice for the benefit of

making it more visible. This factor has forced researchers to remember who their audience is, and to ensure that implementation is made part of the research process rather than being a separate process. Their role must no longer be to keep producing more and more research, but to have in their minds when they publish their findings the ways in which they can help implement it. As well as producing high-quality, valid and reliable research they must help people make decisions and assist their judgement in implementing the findings. They must remember that nurses are often unaware of research findings, may lack critical appraisal skills and may not have the time available to fully implement the research findings. The theory/practice gap exists as a result of the constraints on nurses who may find it difficult to access the, sometimes exclusive, world of research due to their already punishing commitments and lack of research preparation.

It is widely accepted within the UK’s nursing community that a theory/practice gap exists. It is also questionable whether the integration of research into practice has been a success, and unfortunately something of a divide and a certain suspicion has evolved between those who produce research and those who are asked to use it. We all need to work to overcome this for the benefit of our patients.